Architecture to fight against maternal mortality: a project to replicate

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Photo: The Plan Magazine

Imagine you are a woman. You are pregnant, about to give birth. You live in a rural area, the nearest health center is 100 km away, and you have no car. There is no one around with medical skills to help you deliver the baby. What would you do ?

The answer to this question is simple. You will either give birth at home, endangering your own life and the one of the baby, or get on a chariot, cover the 100 km to the health center endangering your life and the one of the baby.

Hundreds of thousand of women in African countries in general and Cameroon in particular are facing that choice virtually every day, hence the frightening figures when it comes to maternal mortality. The case of Malawi is particularly interesting: with 85% of the population living in rural area with little access to professional medical care, maternal mortality has become a common reality.

According to public figures, there are 634 deaths/100,000 live births (2015) from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). 1 in 36 Malawian women had a lifetime risk of dying during pregnancy or delivery. The gap between these figures and those in Cameroon is not that big: 596 deaths/100,000 live births (2015). Why the comparison? Because similar problems can be solved by similar solutions either in Cameroon, in Côte d’Ivoire or in Morocco. In the case of Malawi, architecture played a tremendous part in finding a long lasting solution to solve the issue.

First, the Ministry of Health came up with an idea: a maternity waiting village, made of maternity waiting homes. These facilities were to house expectant mothers, giving them a place to stay within easy reach of a hospital or health center about 6 weeks before giving birth. The idea is for women to go through the final weeks of their pregnancy in the best conditions possible for their health and the health of the baby. They stay in a safe environment surrounded with nurses and very close to a hospital.

When starting the project, the Ministry of Health had few resources to invest in designing the prototype maternity waiting home. The result was one large room housing 36 mothers, with little daylight, ventilation, or privacy in Kasungu. The problem was not solved since women preferred staying home with their loved ones, what seems safer.

In 2013, the architecture firm MASS Design group joined the project. MASS is known for humanitarian projects, including the Butaro District Hospital in Rwanda, the GHESKIO Cholera Treatment Center in Haiti, and the Ilima Primary School in the Democratic Republic of Congo. As one can read in The Plan, MASS Design Group took design cues from the vernacular layout of Malawian villages, where family compounds are composed of several small buildings housing branches of an immediate family. MASS broke the large dormitory-style waiting home into similarly intimate four-bed units, a comfortable size defined in collaboration with mothers. Rather than a sleeping hall’s impersonal scale, the clusters create small communities that encourage knowledge sharing between experienced and first-time mothers.

In Africa, expectant mothers are under the care of family members, and that has been taken into account. Women can stay in the village with up to three family members. For them to be as comfortable as possible, everything has been created with their daily lives in mind: there’s a courtyard with a space for gardening, cooking in a shared kitchen, and laundry done under the shade of a roof that collects rainwater.

According to Rwandan architect Christian Benimana who worked on the project with MASS, “They can live close to how they are living in their own homes in their villages where they spend most of the time in the courtyards with their friends.” The goal was to foster a sense of security and belonging. Director of MASS, Patricia Gruits said “We asked ourselves how do we transform a waiting experience into an empowering experience, how do we make it not only safe, healthy, and comfortable, but build community and dignity? That’s what drove our design.” Kasungu maternity waiting village can house up to 45 women.

Photo: Iwan Baan

What is interesting about this project is how public authorities failed to solve a problem though they were the ones who came up with the idea. The most important thing is not to build facilities supposed to solve a problem. The most important thing is to include beneficiaries in the conception phase of the project and keep their realities in mind to offer the best solution for them first, but also for public funds that will not be wasted as it was the case before the Kasungu maternity waiting village was enhanced. Architecture expertise has been put into action.

We hope countries facing high maternal mortality rates, be they in Africa or elsewhere, will be inspired with this initiative and replicate it following the way of lives of their own people.

For more architectural details on the Kisungu maternity waiting village, you can read this, or this, or even this.

You can also watch Christian Benimana’s TED Talk about the next generation of African architects and designers should put people’s wellbeing and dignity at the heart of each of their project here:

Elle Citoyenne is a bilingual (Fre-Eng) citizen media aiming at educating people on all things pertaining to citizen participation, giving the floor to citizens for them to voice out thoughts and propose solutions to problems experienced by their communities, and promoting citizens' actions for the welfare of their communities.